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Cancer-Related Fatigue

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

What Is Cancer-Related Fatigue?

Fatigue is one of the most common symptoms experienced by those living with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), and it is also commonly overlooked, underreported, and undertreated. This may be due to a lack of awareness that fatigue does not have to be a normal part of having cancer, and that it can be treatable. Those who experience cancer-related fatigue feel exhausted to the point of not being able to perform normal activities throughout the day, and often the fatigue does not improve with additional sleep or rest.

What Are the Differences Between Cancer-Related Fatigue and Tiredness?

Even those without cancer experience periods of tiredness. But feeling tired should not last for very long, and it should drastically improve after getting additional rest. Cancer-related fatigue is not the same as tiredness. With cancer-related fatigue, there is a feeling of intense weakness and an overall lack of energy to perform normal activities. One of the main differences is that getting additional rest or sleep may not improve symptoms. Arms and legs may feel heavy or difficult to move, and the exhaustion may be so extreme that there is no desire to eat or walk to the bathroom even after resting or sleeping for long periods of time.

What Causes Cancer-Related Fatigue?

Cancer-related fatigue is not fully understood, but here are some possible causes:

  • The cancer itself (especially when the cancer is progressing)
  • Cancer treatments (and the fatigue may linger even after the medication is no longer being taken)
  • Emotional factors (depression, stress, and anxiety)
  • Significant anemia, including autoimmune hemolytic anemia
  • Chronic diseases including diabetes, heart disease, and conditions affecting the thyroid, kidney, and liver
  • Vitamin and mineral deficiencies (iron, vitamin D, and vitamin B12)
  • Dehydration
  • Poor nutrition or not eating enough calories
  • Chronic pain
  • Drugs used to treat other symptoms and medical conditions
  • Insomnia or sleep apnea

Are There Any Non-Medical Strategies That Can Help Improve Cancer-Related Fatigue?

There are several strategies that may improve cancer-related fatigue:

  • Exercise: Focus on light activities and movement like stretching and walking, even when it seems counterintuitive due to a lack of energy. Avoid exercise late in the evening. Exercise has been shown to boost energy levels and improve cancer-related fatigue.
  • Nutrition: Not getting enough calories can deplete energy reserves, so it is important to eat a balanced, healthy diet (with plenty of grains, fruits, vegetables, healthy fats, and protein).
  • Hydration: Stay well-hydrated by drinking at least 64 ounces of water per day and limit caffeinated beverages.
  • Conserve Your Energy: It is important to take short rest breaks throughout the day and pace yourself. Keep a written fatigue log so you can easily identify what times of the day you seem to have the most energy.
  • Sleep Hygiene Habits: Go to bed at the same time every day and do your best to get 7-8 hours of uninterrupted sleep each night. If you nap during the day, limit it to one 20-minute nap, as sleeping too much throughout the day can impact how well you sleep at night. Keep the bedroom temperature cool, make sure it is without noise distractions, consider using blackout curtains to keep the room dark, avoid electronics before falling asleep, and try to relax before bedtime by listening to soft music or reading a book.
  • Pace Your Daily Activities: Decide which daily activities are the most important to do, then set small goals throughout the day to complete them.
  • Consider Joining a Support Group: Having a support system in place to help you navigate the additional stress and anxiety that comes along with a cancer diagnosis is a valuable tool that can help manage cancer-related You are not alone.
  • Be Willing to Accept Help: Ask family or friends to help you with things like grocery shopping, meal preparation, and other household
  • Use Relaxation Methods: Finding ways to decrease stress levels and improve relaxation through massage therapy, yoga, and meditation may help improve cancer-related fatigue.

Can My Healthcare Provider Do Anything to Improve My Cancer-Related Fatigue?

It is very important to talk with your healthcare provider about the fatigue so the underlying cause can be identified. Cancer-related fatigue is very nonspecific, and many times there are numerous contributing factors. Identifying and treating other conditions that can cause fatigue (such as depression, insomnia, pain, or other chronic diseases) may greatly improve symptoms.

The first thing your healthcare provider will do is to perform a comprehensive history and physical exam. Simple blood work can be done to check for anemia, thyroid disease, nutritional deficiencies, and other common causes of fatigue.

Depending upon the severity of the fatigue and what the underlying cause is determined to be, your healthcare provider may recommend interventions such as a blood transfusion (for certain types of severe anemia), nutritional supplements (for vitamin and mineral deficiencies), or medication dosage adjustments (if one of your medications is thought to be contributing to the fatigue). Never discontinue or change the dosage of your medications unless it is done in close consultation with your healthcare provider.

Medications such as armodafinil and modafinil can be used to treat sleep-related disorders. Some medications can also be prescribed off-label to treat fatigue (meaning they are not FDA-approved for the specific purpose of treating fatigue). One example of off-label use is Ritalin, which is a stimulant that is approved to treat attention deficit disorder, but is occasionally used to treat cancer- related fatigue.

If no other cause is found, beginning treatment for the CLL or SLL may help. This is because fatigue can be a sign that the cancer is progressing and it may be time to start treatment, even when fatigue occurs alone with no other symptoms.

Never assume fatigue is just part of a cancer diagnosis. If you are experiencing fatigue that is persistent, lasting weeks, or interferes with your ability to go about everyday tasks, don’t hesitate to let your healthcare provider know how it is impacting your life.